2019-20 Wuhan coronavirus
An outbreak of a novel coronavirus, given the designation of 2019-nCoV, was identified around mid-December 2019 in the city of Wuhan in central China when an emerging cluster of people contracted pneumonia with no clear cause. A majority of the earliest cases were directly associated with stallholders who worked at the Huanan Seafood Wholesale Market, which also sold live animals and game meat, though the exact origin of the virus has not been determined. The incubation period of the virus is between 2 and 14 days and it remains contagious during this period of time. Huanan Seafood Wholesale Market was closed from 1 January 2020. Symptoms involve fever, coughing, breathing difficulties and it can be fatal. On 23 January 2020, metro system and bus systems were shut down in Wuhan. Thereafter the next transportation that had been halted also applies to many cities. Only vehicles which are transporting critical supplies or emergency vehicles are allowed to move within the city. Hong Kong also suspended some schools and cancelled CNY celebrations. All travel to China should be halted and deferred. There are two deaths outside Mainland China: the first is in Philippines and the second is in Hong Kong. On 10 February 2020, the death toll surpassed SARS in 2003. Confirmed cases include Singapore, China, Hong Kong, Taiwan, Thailand, Macau, Australia, United States, Japan, Malaysia, South Korea, France, Vietnam and Nepal. Anyone who suspects that they are carrying the virus is advised to wear a protective mask and seek medical advice by calling a doctor rather than directly visiting a clinic in person. United Nations countries has issued warnings against travel to Mainland China. Travellers are advised to monitor their health for at least two weeks. On the 2 February 2020, the first confirmed death outside China had happened in Philippines. However, transport manufacturers CRRC, Yutong, BYD and Zhongtong had suspended production from 1 February 2020 for the CR151 as well as CT251 trains, and affected train manufacturer tie-ups such as for Bombardier Transportation, they were given the option to move to Derby Litchurch Works (CR151) whereas Kawasaki Heavy Industries have given the option to move to Kobe. The outbreak has been declared as a public health of emergency, together with the H5N1 and H5N8 on 2 February 2020. Misinformation spread primarily online has led WHO to declare infodemic at the same time. Further consequences of the epidemic has been discussed in the media, including protest activity in Hong Kong and concerns about the economy and general election caused. Overview Wuhan is the capital of Hubei, and is a major transportation hub. Direct flights also exist to London, Paris, Tokyo, Sydney and Singapore. It had similar outbreaks such as SARS and 2009 flu pandemic (H1N1). In Wuhan, during December 2019, a cluster of cases displaying the symptoms of a "pneumonia of unknown cause" was linked to Huanan Seafood Wholesale Market, which had a thousand stalls selling fish, chickens, pheasants, bats, marmots, venomous snakes, spotted deer, and other wild animals (ye wei, bushmeat). The immediate hypothesis was that this was a novel coronavirus from an animal source (a zoonosis). Coronaviruses mainly circulate among other animals but have been known to evolve and infect humans as in the cases of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) together with four further coronaviruses that cause mild respiratory symptoms similar to the common cold. All coronaviruses known to infect humans have been shown to spread between people. Transmission of coronaviruses is primarily thought to occur among close contacts via respiratory droplets generated by sneezing and coughing. China On 23 January 2020, metro system and bus systems were shut down at Wuhan. Only vehicles which are transporting critical supplies or emergency vehicles are allowed to move within the city. Tangshan suspends public transit on 27 January 2020. Reactions and measures On 27 January 2020, Singapore has imposed 14 days leave of absence for those who travelled to China, in schools and workplaces. Flights in and out of North Korea were halted. Hong Kong declared a state of emergency since January 25, and it will close schools until February 17. Hong Kong Disneyland and Ocean Park is also closed until further notice. Countries also planned to evacuate residents from Wuhan all the way to homes. Hong Kong temporarily closes all ports in the mainland. The high-speed rail service will be suspended from January 30 and all cross-border ferry services are suspended. Air France, British Airways, KLM and Lufthansa suspended all flights to China. The World Health Organization (WHO) announces that its director-general has decided to reconvene their international health regulations emergency committee on 30 January to reconsider declaring a global health emergency. Russia also announces restrictions on railway travel in China, including Trans-Siberian Railway. Overnight stay for pilots at China, Hong Kong, Macau and Taiwan are disallowed, whereas in South Korea it had reported first local human-to-human transmission on 27 January 2020. Every country announces the ban of anyone who travels from China, Hong Kong, Macau and Taiwan beginning 27 January. Hong Kong extends the public holiday until 2 March 2020. The United Kingdom also confirms two patients had been tested positive for the coronavirus. Italy suspends air travel for 6 months from 31 January 2020. Hong Kong also further shut down most of the border crossings with the exception of Hong Kong International Airport and Hong Kong-Zhuhai-Macau Bridge on 3 February 2020. The Japanese Authorities denied entry to any foreign nationals who have been to Hubei province in the past 14 days, even if there is no symptoms of the virus. Japanese officials quarantined a ship whose passenger had contacted the virus. On 4 February 2020, Hong Kong's Cathay Pacific has announced that it will cut down all of the flights to Mainland China. The United Kingdom had directed citizens to leave China as soon as possible, to minimise the risk of exposure to virus. Subsequently on 5 February 2020, United Airlines and American Airlines had shut down all flights to Hong Kong and Singapore-Hong Kong-Chicago also terminated. In addition, the third British citizen who had contracted coronavirus did so through travel to Singapore. "The government is now telling travellers arriving in the UK from a total of nine Asian countries and territories to check for symptoms. They are advised to stay at home and call the NHS if they are ill and have flown home in the past 14 days." On February 4, 2020, the ship was in Japanese waters when 10 passengers were diagnosed with 2019 novel coronavirus during the 2019–20 Wuhan coronavirus outbreak and 3,700 passengers are being quarantined by the Japanese Ministry of Health for 14 days off the Port of Yokohama. On February 6, 10 cases were identified. On February 7, another 41 cases were identified. The total cruise ship cases rise to 61. The White House has asked scientists in the United States and health experts, of the origins of virus. The Mobile World Congress (MWC), due to start on the 24th of February, is cancelled on 13 February. Three people escape a quarantine facility in Russia. One of them escaped by jumping out a hospital window, another by disabling an electronic lock on a door. In addition, Singapore Post will also temporarily stop sending mail or other postal services to China, Hong Kong, Macau and Taiwan, and also flights from Singapore to San Francisco and Los Angeles as in direct were terminated. In addition; Singapore confirmed eight more cases, bringing them to 58. One of the new cases is a family member of a DBS employee, who tested positive for the coronavirus on Wednesday; but this is after the first employee was affected on 12 February. Five of the new cases are linked to the Grace Assembly of God cluster, while two are linked to the cluster at Seletar Aerospace Heights construction site. As such, many temples/churches are either cancelling it or closing it down - these include Clementi Temple, Kuan Yin San Temple, Kwan Im Thong Hood Cho Temple, Tse Tho Aum Temple, St Andrew's Cathedral, Heart of God Church and Bethesda Bedok-Tampines Church. All of them do not have travel histories to China. These were however sent to the restructured hospitals. Prior to hospital admission, he had gone to work at DBS Asia Central at Marina Bay Financial Centre in 12 Marina Boulevard. He had also stayed at his home in Mei Hwan Drive other than to seek medical treatment. In addition; United Kingdom had the first case in London on 12 February 2020. Bizlink has started to do segregation on 17 February 2020, to allow exit only by the back door, for business continuity reasons. The Chinese tourist of France died in coronavirus, the first to do so on 15 February 2020. It had 11 cases. Additionally; more cases were evolved in the Diamond Princess cruise ship in Japan. Additionally; in Singapore there will be 6 more cases on 15 February 2020. Singapore Singapore's Ministry of Health (MOH) issued a health advisory on 2 January, and implemented temperature checks for passengers arriving in Changi Airport from Wuhan the following day. On 20 January, temperature screening at Changi Airport was extended to all travellers coming from China. In addition, individuals with pneumonia who had travelled to Wuhan within 14 days before the onset of symptoms will be isolated in hospital. MOH also issued a reminder to hospitals and general practitioners to be vigilant for such cases. On 22 January, quarantine measures were extended to travellers who arrived from China and displayed symptoms, with the first seven suspected cases tested negative. On the same day, three more suspected cases were detected, causing the MOH to form a multi-ministry taskforce to tackle the virus. The first case was confirmed on 23 January, involving a 66-year-old Chinese national from Wuhan who flew from Guangzhou via China Southern Airlines flight CZ351 with 9 companions and stayed at Shangri-La's Rasa Sentosa Resort and Spa. Contact tracing subsequently commenced. Two more cases were confirmed the next day, involving a 37-year-old son of the first imported case and a 53-year-old Chinese woman who arrived on 21 January by flight and showed preliminary positive results previously. Another 28 suspected cases were detected as a result of enhanced testing. Border control measures were enhanced and extended to land and sea checkpoints on 24 January and the Immigration and Checkpoints Authority started temperature checks from noon of that day. It was reported on 24 January that holiday chalets were being prepared as quarantine centres. Some of these chalets had served as quarantine centres in previous outbreaks, such as the 2003 SARS outbreak and 2009 flu pandemic. Measures such as temperature screening and quarantine facilities were in place at foreign worker dormitories. On 25 January, MOH confirmed the fourth case of Wuhan coronavirus in Singapore involving a 36 year-old from Wuhan who stayed at Village Hotel Sentosa. He subsequently went to Sengkang General Hospital, where infection was confirmed. Schools will also start daily temperature taking exercises from 28 January 2020. In the first phase, temperature screening was originally for flights from Wuhan, China. In response, temperature screening is conducted for all origin locations, and various places on 28 January 2020, as reduction of frequencies is inevitable given peak hours. Hand sanitisers are also installed at these stations to fight virus. Additionally, certain services were suspended in Singapore as a result to the Wuhan virus. *A lot of bus services were suspended or reduced in frequency. *If you are heading to China during the virus outbreak, there will be 14-day leave of absence. This is longer than the Influenza A (H1N1). *In addition, SMRT had suspended train services from Joo Koon to Tuas Plaza on 25 January 2020 as a consequence, but had also suspended train services from Choa Chu Kang to Yew Tee on Chinese New Year 2020. *In Chinese New Year 2020, there is train service extension but up to 1.20am due to coronavirus involved. *Bus service 28 frequency is reduced to 10 - 15 minutes whereas 67 is having an improved frequency. *SBS Transit also had early closures from Bugis to Chinatown on 24 January 2020. Ah Hwee's father and mother did not come on 25 January 2020. On 31 January 2020, 3 more cases for the coronavirus has been reported in Singapore, brings them to the prescribed number slowly to the original 16. On 1 February 2020, it was raised to 18. Therefore on 2 February 2020 it will be raised to 20 or 21. Each household will be distributed with four surgical masks in the early months of February. Mask collection will start free in 1 February 2020 and will end on 8 February 2020. It will be from various residents' committees, as well as community clubs on the last two days of operation. Even though the hand sanitiser (which is already spoilt) had to be thrown away before going to the new house. These masks are meant for the person in the household who is feeling unwell and had to make a trip to the doctor. The distribution came after a scramble for surgical masks, and N95 masks, hand sanitisers and thermometers, which led to retailers with empty shelves and some trying to price gouge their available stocks. In addition, various supermarkets, retailers and pharmacies had run out of stock such as in Tampines and Bugis. There are 13 confirmed cases of the Wuhan coronavirus in Singapore, out of which 2,700 had been dead in China. Eddie Mok's N95 masks were being disposed on September 2019 before we sold the house on 6 December 2019. Many services are 36, 77, 97, 106 and 133. There are seven new coronavirus cases in Singapore, the Ministry of Health announced on Saturday (Feb 8). Among the new confirmed cases are a taxi driver and a private-hire car driver, it said. In addition, affected by 2019-20 coronavirus, Rickshaw Sightseeing Bus will be suspended until further notice. Authorities Precautions Singapore Ducktours (Chinese-language commentaries), Gourmet Bus and Safari Route 2 (Bird Park) will be suspended. Signs and symptoms Those infected may be asymptomatic or have mild to severe symptoms, including fever, cough, shortness of breath, and diarrhea. The time from exposure to onset of symptoms is estimated at 2 to 10 days by the World Health Organization, and 2 to 14 days by the US Centers for Disease Control and Prevention (CDC). Upper respiratory symptoms, such as sneezing, a runny nose, and sore throat, are less frequent. Cases of severe infection can result in pneumonia, kidney failure, and death. Among the first 41 confirmed cases admitted to hospitals in Wuhan, 13 (32%) individuals required intensive care, and 6 (15%) individuals died. Many of those who died had other conditions such as hypertension, diabetes, or cardiovascular disease that impaired their immune systems. As of 13 February 2020, the number of severe cases is 8,047 (13%) out of 60,374 with 6,023 having recovered. Cause Spread Coronaviruses are spread through aerosol droplets expelled when an infected individual coughs or sneezes within a range of about , which can contaminate surfaces like door handles or railings. Coronavirus droplets only stay suspended in the air for a short time, but can stay viable and contagious on a surface for a few hours. Chinese public health officials suggest extra caution for aerosol transmission in closed rooms and recommend regularly exchanging air. Four individuals in Germany later confirmed to have the infection, may have contracted it from an infected but asymptomatic colleague. Viral RNA was detected in stool specimens collected from the first confirmed case in the United States, though it was unclear if enough of the infectious virus was present to suggest fecal-oral transmission. Of the initial 41 cases, two-thirds had a history of exposure to the Huanan Seafood Wholesale Market. There have been estimates for the basic reproduction number (the average number of people an infected person is likely to infect), ranging from 2.13 to 3.11. The new coronavirus has reportedly been able to transmit down a chain of up to four people so far. This is similar to severe acute respiratory syndrome-related coronavirus (SARS-CoV). There are disputed reports that some of the infected may be super-spreaders. On 6 February, the White House asked scientists in the US to investigate the origins and where the virus came from. House cleaning Some houses who have been exposed to Wuhan virus should sanitise the places by mopping with the disinfectant twice. For Simon Ng's house, not just bringing the television back to the living room, it had to clean and disinfect the entire house as well. For Ang Chee Kok's house, cleaning and disinfecting continues to be the norm. The incubation period will vary depending on the pathogen, and will have to be determined through surveillance. The incubation period for human influenza is typically 2 days, with a range of 1 - 4 days. However, human cases of avian influenza have incubation periods around 2 - 8 days and as long as 14 - 17 days. The incubation period for SARS was up to 10 days, and MERS-CoV up to 14 days. Depending on the pathogen, the incubation period for field investigations and monitoring of contacts will also vary correspondingly. During the local epidemic, outpatient care will be provided by polyclinics and participating primary care clinics including Pandemic Preparedness Clinics (PPC). Severe cases will be referred to the hospitals for further treatment. Events Cancelled Public transport Since January 23, all public transport operators have taken the initiative not to deploy staff who had travelled to these places for front-line duties within 14 days of the return to Singapore. At the MRT stations, surfaces in public areas will be cleaned at least thrice a day with disinfectants. These surfaces are handrails, bench seats, lift buttons, fare gates, ticketing machines, locality maps, toilet door handles and taps. Hand sanitisers are installed in all MRT stations and temperature screening will be extended to all MRT stations. For MRT trains, train interiors and exteriors including grab poles and hand grips were cleaned and disinfected both during early morning maintenance hours and late morning to early evening off-peak periods when the trains are withdrawn from service. At bus interchanges, surfaces that commuters frequently come into contact will be cleaned and disinfected by cleaners. These surfaces include railings, seats and passenger service centre counters as well as taps, door knobs and flush buttons in the toilets. List of MRT stations that need temperature screening 27 January 2020 - 1 February 2020: *Ang Mo Kio *Bedok *Bukit Panjang (Downtown Line) *Little India (North East Line & Downtown Line) *Yishun 3 February 2020 - 8 February 2020: *Esplanade *Promenade *City Hall *Novena *Orchard *Somerset *Dhoby Ghaut (North South Line) 10 February 2020 - 15 February 2020: *HarbourFront *Raffles Place *Outram Park *Chinatown *Clarke Quay *Farrer Park 17 February 2020 - 22 February 2020: *Buona Vista *Chinatown *Commonwealth *Dover *Queenstown *Redhill *Serangoon *Tanjong Pagar *Tiong Bahru 24 February 2020 - 29 February 2020: *Admiralty *Bayfront *Boon Lay *Clementi *Downtown *Kent Ridge *Lakeside *one-north *Tampines (East West Line) *Telok Ayer 2 March 2020 - 7 March 2020: *Canberra *Chinese Garden *Choa Chu Kang *Haw Par Villa *Labrador Park *Pasir Panjang *Tampines (Downtown Line) *Pasir Ris *Telok Blangah 9 March 2020 - 14 March 2020: *Botanic Gardens *Changi Airport *Jurong East *Sembawang *Toa Payoh 16 March 2020 - 21 March 2020: *Bishan *Braddell *Bugis *Expo (East West Line & Downtown Line) *Lavender *Yio Chu Kang 23 March 2020 - 27 March 2020: *Kranji *Woodlands Prevention Hand washing is recommended to prevent the spread. The CDC recommends that individuals: *"Wash hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing." *"If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty." The CDC, NHS, and WHO also advise individuals to avoid touching the eyes, nose, or mouth with unwashed hands. Respiratory hygiene Those who suspect they are infected should wear a surgical mask (especially when in public) and call a doctor for medical advice. By limiting the volume and travel distance of expiratory droplets dispersed when talking, sneezing, and coughing, masks can serve a public health benefit in reducing transmission by those unknowingly infected. If a mask is not available, anyone experiencing respiratory symptoms should cover a cough or sneeze with a tissue, promptly discard it in the trash, and wash their hands. If a tissue is unavailable, individuals can cover their mouth or nose with a flexed elbow. Masks are also recommended for those taking care of someone who may have the disease. Rinsing the nose, gargling with mouthwash, and eating garlic are not effective. There is no evidence to show that masks protect uninfected persons at low risk and wearing them may create a false sense of security. Surgical masks are widely used by healthy people in Hong Kong, Japan, Singapore and Malaysia. Surgical masks are not recommended by the CDC as a preventive measure for the American general public. The WHO advises the following best practices for mask usage: *Place mask carefully to cover mouth and nose and tie securely to minimise any gaps between the face and the mask; *While in use, avoid touching the mask; *Remove the mask by using appropriate technique (i.e. do not touch the front but remove the lace from behind); *After removal or whenever you inadvertently touch a used mask, clean hands by using an alcohol-based hand rub or soap and water if visibly soiled *Replace masks with a new clean, dry mask as soon as they become damp/humid; *Do not re-use single-use masks; Discard single-use masks after each use and dispose of them immediately upon removal Healthcare professionals interacting directly with people who have the disease are advised to use respirators at least as protective as NIOSH-certified N95, EU standard FFP2, or equivalent, in addition to other personal protective equipment.